Posterior shoulder dislocation
Nilam faneja
Anjali devaliya
introduction
 Shoulder dislocation have a 3 type.
 1 - anterior dislocation
 2 - posterior dislocation
 3 - inferior dislocation
posterior dislocation is less common then anterior
dislocation.
Introduction
 In posterior dislocation is driving the humeral
head backward. There may be history of direct
blow to anterior side of shoulder.
 In important sign is fixed medial rotation of the
arm. Which can not be rotated outwards even as
far as neutral position.
Demographic data
 Name : Manjulaben joshi
 Age : 72 year
 Gender : female
 Address: panchvati gaushala, shiv krupa, jamangar
 Occupation : retired teacher
 Height : 163 cm
 Weight : 56 kg
 BMI(body mass index) : 21.07 kg/m2 mesomorphic
( 18.5-24.9-normal )
Demographic data
 Hand dominance : right side
 Affected side : left side
 Socioeconomic condition : good
 Provisional diagnosis : closed # with dislocation of
shoulder
 Chief complain : patient have a pain in over head
activity, daily living activity and sleeping on
affected side.
Demographic data
 Investigation : x-ray, posterior dislocation of
shoulder.
History
 Present history : on 16th NOV. 2018 Patient had
forward fall after her leg hit the rock due to loss
of her balance. She suffered from anterior thrust
in her shoulder which started paining a lot so she
went to the doctor on the same day. There patient
was advised x-ray. From x-ray finding doctor
diagnosed her with shoulder dislocation and the
patient was given immobilization for 1 month and
was advised for physiotherapy after 1 month.
patient then came to our opd on 19th dec. 2018 and
is continuing physiotherapy here.
History
 Past history : not relevant
 Surgical history : not relevant
 Medical history : not relevant
 Personal history : not relevant
 Drug history : anti inflammatory, pain killers, anti
acidic drugs (aceclofanc,paracetamol,
serratiopeptidase, ---rabeprazol sodium,
domperidol---atofen sp)
On observation
 1. general – posture
 Standing view –
 Anterior – right
shoulder depress
Posterior view :
right side shoulder
depressed
Lateral view
Right side : slight
foreword head posture
Left side :
slight
foreword
head
posture
:
Protrected
-shoulder
Sitting
Anterior view : right
shoulder depress
Posterior view : right
shoulder
depress
Right lateral view : slight
foreword head posture
Left lateral view :slight
foreword head posture &
protrected shoulder
Supine
Cephalocaudal view : left
protrected shoulder
Gait
 Normal
2. Local
 Deformity : absent
 Swelling : absent
 Redness: absent
 Scar : absent
 trophical changes : absent
On palpation
 Temperature : B/L equal
 Tenderness : anterior joint line of shoulder –grade
2
 Spasm : present at middle fiber of deltoid
 Swelling : absent
 Crepitus : absent
Vital signs
 Temperature : B/L equal
 Blood pressure : 120/90 mmhg
 Respiratory rate : 14 /minute
 Pulse rate : 74 beats /minute
On examination
 Pain assessment :
 onset : sudden pain
 site : anterior aspect of shoulder
 quality : dull aching
 temporal variation : at morning
 aggravating factors : over head activity, left side
lying
 Reveling factors : rest & drugs
Numerical pain rating scale
 at work : 5
 At rest : 0
Range of motion
shoulder
Right
active
flexion
0 - 180
extension
0 -50
Right
passive
End feel
Left
active
Left
passive
End feel
_
Normal
firm
0 -125
0 -130
Abnormal
firm
_
Normal
firm
0 - 50
0 -50
Normal
firm
abduction 0 - 180
_
Normal
firm
0 -110
0 - 120
Abnormal
firm
Internal
rotation
0 - 70
_
Normal
firm
0 -40
0 -45
Normal
firm
External
rotation
0 -90
_
Normal
firm
0 -35
0 -35
Empty
endfeel
elbow
Right
active
flexion
0 -135
extension
135 - 0
Right
passive
endfeel
Left
active
Left
passive
endfeel
_
Soft
0 -135
_
Normal
Soft
_
hard
135 - 0
_
Normal
hard
Cervical
Active
Passive
End feel
flexion
0 - 45
---
Normal firm
extension
0 - 45
----
Normal firm
Right side flexion
0 - 45
----
Normal firm
Left side flexion
0 -35
0 - 45
Normal firm
Right side
rotation
0 - 70
----
Normal firm
Left side
rotation
0 - 70
-----
Normal firm
Interpretation
Left shoulder – flexion, abduction & external
rotation are restricted
Capsular pattern
glenohumeral – present
Glenohumeral pattern –lateral rotation,
abduction
medial rotation.
Manual muscle testing
Cervical + capitulum
Greads
Flexors
5
extensors
5
Scapular muscles
Right side
left side
Upper trap.
5
5
Middle trap.
4
3
Lower trap.
5
4
Rhomboids
4
2
Serratus ant.
5
5
Shoulder
Right side
Left side
Flexors
5
5
Extensors
4
3
Abductors
5
4
Internal rotators
4
4
External rotators
4
4
Elbow
Right
left
Flexors
5
5
Extensors
5
5
Interpretation
 Left side shoulder – extensors are weak (3)
 rhomboids (2) middle(3) & lower (3) trap. are
weak.
Resisted isometric movement
all movements are strong & pain full
>> sensation : intact
>> Reflexes : normal
 upper extremity functional index :
 total score : 52
 pt. score : 43 /52
conclusion : pt. is 82 % functionally independent
ICIDH 2
Anatomiacal impariment : dislocation of shoulder
physiological impariment : weakness of extensors,
middle and lower trap. shoulder ranges are
restricted
activity limitation : difficulties in daily activity
using left hand such as over head activity
participation restrictions : no participation
restrictions
Special test
 APPREHENSION TEST
 LOAD & SHIFT TEST
MANGEMENT
 Short term goals :
 Counseling the pt.for taken physiotherapy
 to increase ROM
 To improve strength of shoulder muscles
to reduce pain
Long term goals
 maintain strength
 maintain ROM
 improve endurance & tolarence
 restoring full function
 preventing recurrent shoulder dislocation
Treatment
 shoulder active assisted exe.
 multiple angle isometric exe. for shoulder
 isometric scapular exe.
 bracing exe.
 rope & pulley
 wand exe.
 finger ladder
 shoulder wheel
 myofascial release(MFR) -for spasms
 scapular mobilization
 ELECRTO THERAPY :
 US – FOR TENDER POINT – 1MHZ,Continuons,0.8
w/cm2, 6 min.
 IFT – For pain relief – 4 EL. , base -80,spectrum -20 ,
10 min.
 HOT PACK - For spasm -10 min.
THANK YOU